Patients lose when hospitals take over doctors

When a big hospital chain buys an independent doctor's office, we often hear the move will "enhance care," "integrate care" or "improve health-care efficiency."

Spare us the euphemisms.

Patients are the losers in these deals.

We pay higher costs. We get fewer choices because doctors are pressured to refer patients only to providers who also work for the hospital. And, because these acquisitions are so common today, an independent doctor's office is becoming as quaint as the house call.

Chances are at least one of your doctors belongs to a practice affiliated with the big guys in town, Florida Hospital or Orlando Health.

This month, the 19 cardiologists and 125 other workers at Florida Heart Group became employees of Florida Hospital Medical Group, which has the same parent company as Florida Hospital. The group now employs 334 doctors at more than 100 locations.

Also this month, Orlando Health put the 95 doctors at Physician Associates on its payroll. The purchase brings Orlando Health's total doctor roster to more than 400, about half of which were formerly independent and purchased in the past 2 1/2 years.

Orlando Health has said costs won't go up at Physician Associates — for now. Florida Hospital President Lars Houmann recently said, "I wouldn't want to be quoted as saying we're not going to raise rates."

There is power in numbers.

That is why marriages between doctors and hospitals are attractive in the first place.

Hospitals can big-foot rate negotiations with insurance companies.

If Claims-R-Us Insurance tries to hold out for lower rates (which means lower costs to be passed along to employers who offer the plans and employees who pay premiums), they will be crushed by Sasquatch Hospital Inc.

The Florida Hospital-United Healthcare showdown of 2010 made that much clear.

United initially balked at Florida Hospital's demand for higher payments. So the hospital threatened to cut off United's 170,000 local customers. Suddenly a deal was reached.

The ability of hospitals to throw their weight around is why, for example, an echocardiogram administered by a hospital-affiliated doctor costs $647 under one of Cigna's plans. The same test administered by an independent doctor under the same plan would cost the insurance company just $238.

Why do you care? Because insurance plans typically make patients pay a portion of the cost for that test.

Of course, the insurance companies just pass those higher rates on to employers who buy their plans, who then raise costs on their employees who pay the premiums.

So patients pay more for their insurance plans and then, if their doctor is bought by a big hospital, they could pay more when they get sick and need a test or procedure.

"I can't find an incentive for an insurance company to cap those costs because they're not truly paying the bill," said Christi Hudiburg, administrator for Orlando Heart Specialists, which remains independent. "Maybe there's one out there, but I haven't been able to find it."

Another woman I talked with, who didn't want to be named for privacy reasons, said a relative she helps care for now pays double for blood tests and pacemaker checks by her cardiologist since he joined a hospital payroll.

Same office. Same equipment. Same humbling paper gown. But twice the cost.

Welcome to the insanity of our medical system.

In addition to potentially higher rates, the hospitals have another reason for snapping up doctors' offices.

As insurance companies continue to put more emphasis on preventive care and quality of outcomes (such as low infection rates, fewer readmissions to the hospital), hospitals have to think about how to make money if fewer hospital beds are filled. One answer is getting in on the business of doctors' offices.

So what is a patient to do?

Many of us spend more time researching the price and quality of our next flat-screen television than we do our own potentially life-saving medical care.

You can research your out-of-pocket costs for health care based on the type of procedure you need and the doctor that provides it. Most insurance plan websites have tools to help you comparison shop your next MRI or cardiac stress test.

If you're curious about reviews of your doctor's office, try a simple Google search or a site such as healthgrades.com. You can also find out whether the office is recognized by the National Committee for Quality Assurance (ncqa.org), a nonprofit that works with Consumer Reports to rank insurance plans and also offers a recognition program doctors can apply for.

And if your doctor's office is owned by a hospital (ask if you're not sure), don't be afraid to ask for one or two referrals outside the hospital system so you know all of your options.

It may be that the surgeon or radiologist connected with the hospital is the best choice, but there's nothing wrong with seeing what else is available.

In this new world of consolidated hospital power, it's more important than ever for patients to look out for themselves.